1 / 11

Anesthesia for Drug Abusers

Anesthesia for Drug Abusers. Clinton Piper, MS3. Anesthesia for Drug Abusers. - Narcotics - Barbs and Benzos - Hallucinogens - Amphetamines - Cocaine. Nick Nolte, 2002. Narcotics - Heroin, Morphine, Meperidine, Fentanyl, etc. Heroin OD? Find John Travolta and some adrenaline.

marlin
Download Presentation

Anesthesia for Drug Abusers

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Anesthesia for Drug Abusers Clinton Piper, MS3

  2. Anesthesia for Drug Abusers - Narcotics - Barbs and Benzos - Hallucinogens - Amphetamines - Cocaine Nick Nolte, 2002

  3. Narcotics - Heroin, Morphine, Meperidine, Fentanyl, etc Heroin OD? Find John Travolta and some adrenaline

  4. Narcotics - Heroin, Morphine, Meperidine, Fentanyl, etc - Anesthesia risks… - hypotension (from adrenal suppression) - perioperative respiratory depression --> avoid narcotic premedication - Chronic user -->Continue normal drug dose during procedurerecovery - PTs often undertreated for pain...use aggressive dosing for analgesics - Avoid opioid antagonists (naloxone)

  5. Barbs and Benzos - Inhaled anesthetics may need to be adjusted - Acute intoxication → decreases MAC of inhaled agents - Chronic use --> increases MAC - Minimal organ sys changes (vs narcotics) - Hepatic enzyme induction --> increased IV anesthetic requirements - Abrupt withdrawl --> delirium, seizures, hypotension - Overdose - NG lavage and urine alkalinization

  6. Hallucinogens - LSD, Mushrooms (Psilocybin), Mescaline, etc - Hallucinogens have long lasting effects 2 – 8 hrs. - Watch for autonomic disturbances (mediated by hypothalmamus) - Tachycardia, HTN, increased secretions, N/V, rare seizures - Treat w alpha and beta blockade - Stress of surgery/anesthesia --> psychotic reaction (flashbacks) - Rx: Thorazine, diazepam, barbs

  7. Pop quiz hotshot... Which acceptable is slang for Amphetamines?? A. Black Molies, RoadDope, Turkey B. L.A. Turnarounds, SparklePlenty, Bombido C. Benny and the Jets, Cartwheels, Jam Cecil D. Truckdrivers, Snow Seals, MinnieBennie

  8. Pop quiz hotshot... Which acceptable is slang for Amphetamines?? A. Black Molies, RoadDope, Turkey B. L.A. Turnarounds, SparklePlenty, Bombido C. Benny and the Jets, Cartwheels, Jam Cecil D. Truckdrivers, Snow Seals, MinnieBennie ANSWER: ALL OF THE ABOVE

  9. Amphetamines - Stimulate alpha and beta receptors, increase catecholamine release/inhibits reuptake - Acuteintoxication → increases MAC - Chronic abuse - decreases MAC (opposite of Barbs/Benzos) - blunts response to indirect-acting vasopressors - hypotension may require epinephrine - Extremely high doses → toxic delirium, coma, cerebral hemorrhage, circulatory collapse - Rx: Thorazine or Haldol; alpha and beta block, NG lavage, urine acidification

  10. Cocaine - Stimulates dopaminergic neurons, inhibits NorEpi reuptake - Autonomic effects...HTN, Tachy, Arrythmias, Hyperpyrexia - Incrisk of cardiac events and seizures during surgery - Acute intoxication → increases MAC - Volatile anesthetics are acceptable - Avoid Ketamine, gallamine, and pancuronium - aggressive sedation with barbs/benzos/haldol

  11. Keys to 'Winning' - Narcotics - Don't undertreat pain - Watch for hypotension/respiratory depression - Barbs and Benzos - Adjust MAC (Acute --> dec; Chronic --> inc) - Inc IV anesthetics (hepatic enzyme induction) - Hallucinogens - watch out for inc. secretions and flashbacks - helps to play Grateful Dead in OR - Amphetamines - Adjust MAC (Acute --> inc; Chronic --> dec) - Cocaine - Adjust MAC (Acute --> inc) - Avoid Ketamine

More Related